胸腰椎体骨折合并脊髓受压患者手术时间及不同手术方案的选择

Analysis of the effect of different operation scheme treated patients with vertebral body fracture and spinal cord compression

目的比较不同手术方案治疗椎体骨折合并脊髓压迫患者及其恢复情况,探讨临床治疗最佳手术方案的选择。方法选取2006年5月至2014年9月,我院收治的椎体骨折合并脊髓受压手术患者54例作为研究对象。分为手术组和保守治疗组(3例),其中手术组根据患者不同情况,行后路减压内固定(14例)、骨折复位钉棒系统内固定(16例)、前路减压植骨融合双棒内固定系统(21例)手术治疗3种方案。术后随访以Oswestry功能障碍指数(ODI)和疼痛视觉模拟评分(VAS)问卷为评价指标,记录患者术前,术后1周、1个月、3个月及6个月的评分。结果随访1年中,手术组患者无后凸加重及内固定松动、脱落等并发症,植骨融合,恢复状态良好;保守治疗组1例出现再发骨折。手术组以及保守治疗组相比,术前VAS和ODI评分差异均无统计学意义(均P>0.05);治疗后1周、1个月、3个月和6个月,手术组患者VAS和ODI指数均低于保守治疗组,差异有统计学意义(均P<0.01)。结论手术治疗椎体合并脊髓压迫方案优于保守治疗组;三柱损伤有脱位合并脊髓压迫患者应优先选择骨折复位钉棒内固定术式;骨折椎管侵占率大于50%、后纵韧带和椎间盘纤维环破裂严重患者,优先选择前路减压植骨融合术式;而后路减压内固定方案则主要适用于单椎体骨折患者。

Objective To investigate the optimal treatment cord compression through different operation schemes. Methods for the patients with vertebral body fracture and spinal 54 patients with vertebral body fracture and spinal cord compression were divided into conservative treatment group （3 cases） and surgery group （according to different conditions of patients, selecting fixation after posterior decompression （14 cases）, reset screw rod system fixation for fracture （16 cases）, anterior decompression fusion with internal fixation （21 cases） for treatment）. Follow-up was conducted by telephone survey （l week-6 months） for evaluating Oswestry disability index （ODD and visual analogue scale （VAS） score, recorded the data of patients before and after operation. Results For follow-up of surgical treatment for 6 months, no patients had kyphotic aggravating or internal loosening fixation/shedding complications. All patients recov- ered in good conditions with the bone graft fusion. The conservative treatment group occurred in 1 case of refracture. Compared surgery group with conservative treatment group, VAS and ODI scores before operation showed no significant differences （all P〈0.05）. VAS and ODI scores 1 week, 1 month, 3 months and 6 months after operation of operation group were lower than that in conservative treatment group （P〈0.01）. Conclusion when treated patients with vertebral body fracture and spinal cord compression, operation is better than conservative treatment. Choosing the best operation scheme should obey the principle of particular analysis used for particular case.